High Risk Of Bacterial Infections Research Articles

Evaluation of mucosal-associated invariant T-cells as a potential biomarker to predict infection risk in liver cirrhosis.

Infection is a serious complication in patients with cirrhosis. Mucosal-associated invariant T (MAIT) cells are involved in the immune defense against infections and known to be impaired in several chronic conditions, including cirrhosis. Here, we evaluated if MAIT cell levels in peripheral blood are associated with risk of bacterial infections in patients with cirrhosis. Patients with cirrhosis seen at the Karolinska University Hospital, Stockholm, Sweden, between 2016 and 2019 were included. Levels of MAIT cells in peripheral blood were determined using flow cytometry. Baseline and follow-up data after at least two years of follow-up were collected by chart review for the primary outcome (bacterial infection) and secondary outcomes (decompensation and death). Competing risk and Cox regression were performed. We included 106 patients with cirrhosis. The median MAIT cells fraction in the circulation was 0.8% in cirrhosis compared to 6.1% in healthy controls. In contrast to our hypothesis, we found an association in the adjusted analysis between relatively preserved MAIT cell levels, and a slightly higher risk to develop bacterial infections (adjusted subdistribution hazard ratio (aSHR) 1.15 (95%CI = 1.01-1.31). However, MAIT cell levels were not associated with the risk of hepatic decompensation (aSHR 1.19 (95%CI = 0.91-1.56)) nor with death (adjusted hazard ratio 1.10 (95%CI = 0.97-1.22)). Relatively preserved MAIT cell levels in blood of patients with cirrhosis were associated with a somewhat higher risk of bacterial infections. The clinical relevance of this might not be strong. MAIT cells might however be an interesting biomarker to explore in future studies.

Smart Enzyme-Like Polyphenol-Copper Spray for Enhanced Bacteria-Infected Diabetic Wound Healing.

Developing functional medical materials is urgent to treat diabetic wounds with a high risk of bacterial infections, high glucose levels and oxidative stress. Here, a smart copper-based nanocomposite acidic spray has been specifically designed to address this challenge. This copper-based nanocomposite is pH-responsive and has multienzyme-like properties. It enables the spray to effectively eliminate bacteria and alleviate tissue oxidative pressure, thereby accelerating the healing of infected diabetic wounds. The spray works by generating hydroxyl radicals through catalysing H2O2, which has a high sterilization efficiency of 97.1%. As alkaline micro-vessel leakage neutralizes the acidic spray, this copper-based nanocomposite modifies its enzyme-like activity to eliminate radicals. This reduces the level of reactive oxygen species in diabetic wounds by 45.3%, leading to a similar wound-healing effect between M1 diabetic mice and non-diabetic ones by day 8. This smart nanocomposite spray provides a responsive and regulatedmicroenvironment for treating infected diabetic wounds. It also offers a convenient and novel approach to address the challenges associated with diabetic wound healing.

High Number of Plasma Exchanges Increases the Risk of Bacterial Infection in ABO-incompatible Living Donor Liver Transplantation.

Bacterial infections are major complications that cause significant mortality and morbidity in living donor liver transplantation (LDLT). The risk of bacterial infection has not been studied in ABO-incompatible (ABOi) recipients with a desensitization protocol in relation to the number of plasma exchanges (PEs). Therefore, we aimed to analyze the risk of bacterial infection in ABOi LDLT recipients with a high number of PEs compared with recipients with a low number of PEs. A retrospective study was performed with 681 adult LDLT recipients, of whom 171 ABOi LDLT recipients were categorized into the high (n = 52) or low (n = 119) PE groups based on a cutoff value of 6 PE sessions. We compared bacterial infections and postoperative bacteremia within 6 mo after liver transplantation with the ABO-compatible (ABOc) LDLT group (n = 510) as a control group. The high PE group showed a bacterial infection rate of 49.9% and a postoperative bacteremia rate of 28.8%, which were significantly higher than those of the low PE group (31.1%, 17.8%) and the ABOc group (26.7%, 18.0%). In multivariate analysis, the high PE group was found to have a 2.4-fold higher risk of bacterial infection (P = 0.008). This group presented a lower 5-y survival rate of 58.6% compared with the other 2 groups (81.5% and 78.5%; P = 0.030 and 0.001). A high number of preoperative PEs increases bacterial infection rate and postoperative bacteremia in ABOi LDLT.

Preparation and investigation of a novel antibacterial collagen-based material loaded with gentamicin following surface modification with citric acid for corneal tissue engineering

Corneal disease is an important clinical problem that affects millions of blind people and keratoplasty is currently the most successful treatment for corneal blindness. Unfortunately, there is a very high risk of bacterial infection during corneal transplantation. In this study, we proposed a novel synthetic collagen-based film for corneal therapy, and we effectively incorporated aminoglycoside gentamicin molecules onto the surface of the collagen film. We anticipate that this collagen-based substance will be antimicrobial and repair corneal tissue damage. Three steps were used to create this gentamicin-modified carboxylated collagen film, including: (i) Cross-link the collagen molecules with 1-ethyl-3- (3-dimethylaminopropyl) carbodiimide and n-hydroxysuccinimide to create a collagen (Col) film. (ii) Citric acid was used to modify the Col film's surface in order to increase the number of carboxyl groups there (ColCA). (iii) Gentamicin molecules were grafted onto the surface of ColCA film by forming amide bonds (ColCA-GM). We discovered that this ColCA-GM film has good physicochemical properties and excellent biocompatibility. Furthermore, it was demonstrated that treating collagen films with citric acid significantly improved the antibacterial properties of ColCA-GM film. The outcomes point to a variety of potential applications for this novel film in corneal tissue engineering.

Antibacterial, conductive nanocomposite hydrogel based on dextran, carboxymethyl chitosan and chitosan oligosaccharide for diabetic wound therapy and health monitoring

Diabetic severe wound healing is challenging and also carries a high risk of bacterial infection and may be accompanied by serious complications. Electrical stimulation (ES) can effectively promote wound healing, but its effectiveness is often limited by incomplete contact between the electrodes and the wound site. In order to improve the efficiency of electrical stimulation utilization and to avoid wound infection, a multi-dynamically crosslinked nanocomposite hydrogel was prepared from dextran modified with aldehyde groups and phenylboronic acid esters (Dex-FA-BA), carboxymethyl chitosan (CMCS), polyaniline grafted chitosan oligosaccharide (CP), and Epigallocatechin Gallate/Ca2+ modified melanin-like nanoparticles (CEMNPs), based on dynamic Schiff base bonds, phenylboronic acid/diol interactions, and hydrogen bonding. The CEMNPs have good photothermal conversion properties and antioxidant activity and can also enhance the mechanical properties of the hydrogel system. The CP endows the hydrogel with good electrical conductivity and sensing properties and can record the respiratory and heart rate of rats in real time. Based on the convolutional neural networks (CNN) algorithm constructed by ResNet9, the respiratory and heart rate signals can be distinguished with 93.9 % accuracy. This multifunctional nanocomposite hydrogel can provide a new strategy to promote chronic wound healing and achieve health monitoring effectively.

FRI-551 - Lower free and total serum cortisol levels are associated with higher risk of bacterial infection and acute-on-chronic liver failure in stable outpatients with advanced chronic liver disease

FRI-551 - Lower free and total serum cortisol levels are associated with higher risk of bacterial infection and acute-on-chronic liver failure in stable outpatients with advanced chronic liver disease

Bacterial profile, their antibiotic susceptibility pattern, and associated factors of urinary tract infections in children at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Urinary tract infections (UTIs) are common pediatric infections and contribute to high morbidity and mortality. At present, the antimicrobial resistance emergency has quadrupled worldwide and poses a serious threat to the treatment of patients. However, there have been few studies on UTIs in children in Ethiopia, particularly in the east. This study aimed to assess the bacterial profile of urinary tract infections, their susceptibility to antimicrobial agents, and associated factors in under-five children at Hiwot Fana Specialized University Hospital, eastern Ethiopia. We conducted hospital-based quantitative study on 332 consecutively selected under-five children from March 20 to June 10, 2021. Parents and guardians were interviewed to collect data using a structured questionnaire. Random urine samples were collected aseptically, and standard microbiological techniques were used to identify the bacteria and test for susceptibility to various antibiotics. Data were entered into Epi Info version 7 and exported to Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Data were analyzed using descriptive analysis, bivariate, and multivariable logistic regression analysis. The crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CI) were used to determine the significance of the predictors. A p-value at a 95% confidence interval of less than 0.05 was considered statistically significant. The overall prevalence of bacterial urinary tract infections was 80 (24.1%) 95% CI:19.40-29.00%). Most of the bacterial isolates 55 (68.75%) were gram-negative bacteria, predominantly E. coli 23 (28.75%) and K. pneumoniae 10 (12.50%). Being a rural resident (AOR: 4.10, 95%CI: 1.45 11.54), uncircumcised male (AOR: 3.52, 95%CI: 1.33, 9.39), previous history of antibiotic usage (AOR: 7.32, 95%CI: 2.11, 25.37), indwelling catheterization (AOR: 10.35, 95%CI: 3.74, 28.63), previous history of urinary tract infections (AOR: 5.64, 95% CI: 1.36, 23.38), and urinary frequency (AOR: 5.56, 95%CI: 2.03, 15.25) had higher odds of culture positive result. The majority of the isolates have shown high levels of antibiotic resistance. Meropenem, ciprofloxacin, and amoxicillin-clavulanic acid were effective against gram-negative uropathogens, whereas rifampin and ciprofloxacin were the most sensitive drugs for gram-positive isolates. From the tested bacterial isolates, 53/86 (61.6%), 11/86 (11.6%), and 2/86 (2.3%) were found to have multidrug resistance (MDR), extreme drug resistance (XDR), and pan drug resistance (PDR), respectively. About one-fourth of the children were culture-positive for many types of bacterial uropathogens; this is higher compared with most of the previous studies in Africa. Rural dwellers, uncircumcised males, indwelling catheterization, a history of antibiotic use and urinary tract infection, and frequent urination all had a higher risk of bacterial infections. Many isolates were resistant to multiple drugs, primarily beta-lactams. Urinary tract infections as well as the growth and spread of resistant bacterial pathogens should be monitor regularly.

Meropenem loaded 4-arm-polyethylene-succinimidyl-carboxymethyl ester and hyaluronic acid based bacterial resistant hydrogel

Developing an ideal vitreous substitute/implant is a current challenge. Moreover, implants (e.g., heart valves and vitreous substitutes), are associated with a high risk of bacterial infection when it comes in contact with cells at implant site. Due to infection, many implants fail, and the patient requires immediate surgery and suffers from post-operative problems. To overcome these problems in vitreous implants, we developed a bacterial resistant vitreous implant, where meropenem (Mer), an antibiotic, has been incorporated in a hydrogel prepared by crosslinking HA (deacetylated sodium hyaluronate) with 4-arm-polyethylene-succinimidyl-carboxymethyl-ester (PESCE). The HA-PESCE hydrogel may serve as a suitable artificial vitreous substitute (AVS). The pre-gel solutions of HA-PESCE without drug and with the drug are injectable through a 22 G needle, and the gel formation occurred in approx. 3 min: it indicates its suitability for in-situ gelation through vitrectomy surgery. The HA-PESCE hydrogel depicted desired biocompatibility, transparency (>90 %), water content (96 %) and sufficient viscoelasticity (G′ >100 Pa) calculated after 1 month in-vitro, which are suitable for vitreous substitute. The HA-Mer-PESCE hydrogel showed improved biocompatibility, suitable transparency (>90 %), high water content (96 %), and suitable viscoelasticity (G′ >100 Pa) calculated after 1 month in-vitro, which are suitable for vitreous substitute. Further, hydrogel strongly inhibits the growth of bacteria E.coli and S.aureus. The drug loaded hydrogel showed sustained in-vitro drug release by the Fickian diffusion-mediated process (by Korsmeyer-Peppas and Peppas Sahlin model). Thus, the developed hydrogel may be used as a potential bacterial resistant AVS.

Shoulder joint septic arthritis with scapular osteomyelitis a rare presentation in an infant with sickle cell disease: a challenging diagnosis; a case report from rural central India

Sickle-cell disease (SCD) a hereditary autosomal recessive disorder is the most common haemoglobinopathy worldwide. In India, it is the second most common haemoglobinopathy next to Thalassemia, prevalent in the tribal population of Central and Southern parts of India. The pathophysiology of the disease is point mutation in the beta globin chain leading to sickling of RBCs which causes obstruction in microvasculature leading to acute events like Vaso-occlusive crisis. Patients with SCD are also at an increase of orthopaedic manifestation like osteomyelitis, septic arthritis or osteonecrosis. We report a case of a 10 months old male child who presented with anaemia and fever. Child was diagnosed with SCD, later developed swelling of right shoulder joint and restrictions of movements. Diagnosis of septic arthritis of shoulder with scapular osteomyelitis was made with the help of radiological and laboratory investigations. Child was managed with injectable antibiotics and symptomatic treatment. Patients with SCD as a result of occlusion of microvasculature along with immunocompromised state are at higher risk of bacterial infections. Osteomyelitis is one of the dreaded complications. Its clinical presentation is similar to that of VOC hence there occurs a dilemma in diagnosis. A multidisciplinary approach including high degree of clinical suspicion, laboratory investigation and radiological imagining can help in early diagnosis and management.

Multifunctional antibiotics-free hydrogel dressings with self-regulated nitric oxide-releasing kinetics for improving open wound healing.

Healing of large open wounds remains a major challenge in clinics due to the high risk of bacterial infection and slow healing rates, while excessive use of antibiotics would cause enhanced antibiotic resistance and reduced biocompatibility. Herein, we developed a multifunctional hydrogel dressing (GCNO) through embedding nitrosothiol-conjugated chitosan into a crosslinked gelatin methacrylate (GelMA) network via hydrogen bonding, which presented self-regulated nitric oxide (NO) release kinetics for temporally controlled bacterial elimination and wound repair. At early stages after implantation, the positively charged chitosan molecules of the GCNO hydrogel precursors and release of a high level of NO from the GCNO hydrogel demonstrated effective coordinated antimicrobial capability, thus preventing wound infection in the early stages of healing. While at later stages of wound healing, the hydrogel could sustainably release low levels of NO to stimulate the proliferation and migration of fibroblasts and endothelial cells, leading to accelerated angiogenesis and cell deposition at the wound area. GCNO hydrogels exhibited anti-bacterial and wound repair performance with excellent biocompatibility and biosafety. Overall, this antibiotic-free GCNO hydrogel could demonstrate self-adaptive NO release profiles to prevent bacterial infection in early stages of wound healing while accelerating skin regeneration at later stages, which may offer new insights for the clinical management of large open wounds in clinics.

Decorated Polyetheretherketone Implants with Antibacterial and Antioxidative Effects through Layer-by-Layer Nanoarchitectonics Facilitate Diabetic Bone Integration with Infection.

Patients suffering diabetic bone defects still need some new and effective strategies to achieve enhanced prognostic effects. Although medical implants are the common treatment of bone defects, the excessive oxidative stress and high risk of bacterial infection in diabetes mellitus lead to a higher risk of implant failure. To improve the healing ability of diabetic bone defects, herein, polyetheretherketone (PEEK) was modified through a developed layer-by-layer (LBL) construction strategy to obtain multifunctional PEEK (SP@(TA-GS/PF)*3) by the assembly of tannic acid (TA), gentamicin sulfate (GS) and Pluronic F127 (PF127) on the basis of prepared porous PEEK through sulfonation (SPEEK). The prepared SP@(TA-GS/PF)*3 exhibited sustained antimicrobial activity and enhanced the differentiation of osteoblast (MC3T3-E1) for needed osteogenesis. Moreover, SP@(TA-GS/PF)*3 scavenged excessive oxidative stress to promote the growth of H2O2 damaged HUVEC with enhanced secretion of VEGF for neovascularization. In addition, the remarkable in vivo outcomes of angiogenesis and osseointegration were revealed by the subcutaneous implant model and bone tissue implant model in diabetic rats, respectively. The in vitro and in vivo results demonstrated that modified PEEK with multifunction can be an attractive tool for enhancing bone integration under diabetic conditions, underpinning the clinical application potential of modified implants for diabetic osseointegration.

Incidence and risk factors for bacterial infection using bortezomib, lenalidomide, and dexamethasone (RVd) in newly diagnosed multiple myeloma

Infections are an important cause of morbidity and mortality in newly diagnosed multiple myeloma (NDMM), but the real-world risk using modern induction regimens such as bortezomib, lenalidomide, and dexamethasone (RVd) is not well described. We performed a retrospective single-center cohort study to identify infections and risk factors in patients treated with first-line RVd from January 2014 to January 2020 and collected demographic and clinical data. Of 144 patients treated with RVd for NDMM, 21 patients (14.5%) experienced a bacterial infection during induction, of which 8 (5.5%) were grade 3 infections despite a low rate of antibiotic prophylaxis use (12%). Grade 3 neutropenia occurred in 11% of patients, 2% had febrile neutropenia and there were no deaths from infection. On multivariable analysis, age, smoking history, diabetes, antibiotic use in the 60 days preceding the start of RVd, and high-risk cytogenetics were associated with higher risk of bacterial infection.

Hydrogels for the treatment of radiation-induced skin and mucosa damages: An up-to-date overview

Radiation-induced damages are difficult to heal than normal wounds. This is because radiation therapy could lead to an imbalanced inflammatory response, oxidative stress response, lack of angiogenesis, and a high risk of bacterial infection, which are considered to be the greatest challenges in radiation-induced damages treatment. Hydrogels are semi-occlusive and are composed of complex hydrophilic polymers with a higher water content. Due to their excellent mechanical and biochemical property (such as adhesiveness, antibacterial, and antioxidant abilities), hydrogels represent a promising strategy that has achieved potent therapeutic efficacy in the treatment of radiation-induced skin and mucosa damages. This review systematically and comprehensively summarizes the recent progress of various types of hydrogels such as natural biopolymer, synthetic polymer, composite hydrogels and commodity dressings for the treatment of radiation-induced skin and mucosa damages.

Dual Regulatory Role Exerted by Cyclic Dimeric GMP To Control FsnR-Mediated Bacterial Swimming.

ABSTRACTBacterial motility has great medical and ecological significance because of its essential role in bacterial survival and pathogenesis. Cyclic dimeric GMP (c-di-GMP), a second messenger in bacteria, is the predominant regulator of flagellar synthesis and motility and possesses turnover mechanisms that have been thoroughly investigated. Therefore, much attention has been focused on identifying the upstream stimulatory signals and downstream modules that respond to altered c-di-GMP levels. Here, we systematically analyzed c-di-GMP cyclases and phosphodiesterases in Stenotrophomonas maltophilia to screen for motility regulators. Of these enzymes, we identified and characterized a new phosphodiesterase named SisP, which was found to facilitate bacterial swimming upon stimulation with ferrous iron. SisP-mediated degradation of c-di-GMP leads to FsnR-dependent transcription of flagellar genes. Remarkably, c-di-GMP controls FsnR via two independent mechanisms: by direct binding and indirectly by modulating its phosphorylation state. In this study, we deciphered a novel “one stone, two birds” regulatory strategy of c-di-GMP and uncovered the signal that stimulates c-di-GMP hydrolysis. Facilitation of bacterial swimming motility by ferrous iron might contribute to the higher risk of bacterial infection in acutely ill patients.

Post-Transplantation Cyclophosphamide Versus Tacrolimus and Methotrexate Graft-Versus-Host Disease Prophylaxis for HLA-Matched Donor Transplantation

The use of post-transplantation cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis is increasing in patients undergoing HLA-matched sibling (MSD) or unrelated (MUD) donor hematopoietic cell transplantation (HCT), but data about its comparative efficacy against the traditional GVHD prophylaxis are scarce. Two broad questions assessed in this study were (a) comparison of PTCy-based GVHD prophylaxis versus Tac/MTX (without ATG) in the MSD and (b) comparison of PTCy-based GVHD prophylaxis versus Tac/MTX (with ATG) in the MUD group. This retrospective single-center study analyzed the outcomes of 964 patients who received Tac/MTX (n=578) versus PTCy-based (n=386) GVHD prophylaxis. All MUD recipients in the Tac/MTX group also received ATG; thus separate analyses were conducted for MSD (n=412) and MUD (n=552) cohorts. In the MUD cohort, 306 patients received Tac/MTX/ATG and 246 received PTCy-based GVHD prophylaxis. In the MSD cohort, 272 received Tac/MTX and 140 received PTCy-based prophylaxis. Both PTCy groups included somewhat older patients than the Tac/MTX groups and more patients had myeloid malignancy (85%-90% versus 59%-64%, respectively). A majority of patients in all groups received myeloablative conditioning and peripheral blood graft. Both PTCy groups had a significantly delayed neutrophil engraftment, higher risk of hemorrhagic cystitis, and higher risk of bacterial infections than the Tac/MTX groups. The risks of viral infections and related deaths were significantly higher in Tac/MTX group in the MUD cohort. In multivariate analysis, the risk of grade III-IV acute GVHD was similar in PTCy and Tac/MTX groups in both MSD and MUD cohorts, but the risk of chronic GVHD was significantly lower with PTCy in the MSD cohort. PTCy was associated with a significantly lower risk of non-relapse mortality and better progression-free survival in the MUD. PTCy was associated with improved GVHD-free relapse-free survival in both MSD and MUD groups. Our data suggest a benefit of using PTCy-based GVHD prophylaxis in both MSD (versus Tac/MTX) and MUD (versus Tac/MTX/ATG) HCT.

Reassessing the Performance of the "Step-By-Step" Approach to Febrile Infants 90 Days of Age and Younger in the Context of the COVID-19 Pandemic: A Multicentric Retrospective Study.

Background:Infants with COVID-19 can often present with fever without source, which is a challenging situation in infants <90 days old. The “step-by-step” algorithm has been proposed to identify children at high risk of bacterial infection. In the context of the COVID-19 pandemic, we aimed to reassess the diagnostic performance of this algorithm.Methods:We performed a multicentric retrospective study in 3 French pediatric emergency departments between 2018 and 2020. We applied the “step-by-step” algorithm to 4 clinical entities: COVID-19, febrile urinary tract infections (FUTI), invasive bacterial infection (IBI), and enterovirus infections. The main outcome was the proportion of infants classified at high risk (ill-appearing, ≤21 days old, with leukocyturia or procalcitonin level ≥0.5 ng/mL).Results:Among the 199 infants included, 40 had isolated COVID-19, 25 had IBI, 60 had FUTI, and 74 had enterovirus infection. All but 1 infant with bacterial infection were classified at high risk (96% for IBI and 100% for FUTI) as well as 95% with enterovirus and 82% with COVID-19. Infants with COVID-19 were classified at high risk because an ill-appearance (72%), an age ≤21 days (27%), or leukocyturia (19%). All these infants had procalcitonin values <0.5 ng/mL and only 1 had C-reactive protein level >20 mg/L.Conclusions:The “step-by-step” algorithm remains effective to identify infants with bacterial infection but misclassifies most infants with COVID-19 as at high risk of bacterial infection leading to unnecessary cares. An updated algorithm based adding viral testing may be needed to discriminate fever related to isolated COVID-19 in infants <90 days old.

Antibacterial adhesive self-healing hydrogels to promote diabetic wound healing

The development of compressible, stretchable and self-healing hydrogel dressings with good adhesive, antibacterial and angiogenesis properties is needed to promote the regeneration of diabetic wounds in clinical applications. In this work, a series of self-healing, adhesive and antibacterial hydrogels based on gelatin methacrylate (GelMA), adenine acrylate (AA), and CuCl2 were designed through covalent bonding, coordination complexation of Cu2+ and carboxyl groups and hydrogen bonding to promote diabetic wound healing. These hydrogels exhibit efficient self-healing properties, remarkable fatigue resistance, and good adhesive properties due to the hydrogen bond and the metal-ligand coordination provided by the Cu2+ and the carboxyl group. The GelMA/AA/Cu1.0 hydrogel (containing 1.0 mg/mL Cu2+) with well-balanced biocompatibility and antibacterial properties exhibited efficient hemostatic performance in a mouse liver trauma model and significantly promoted the healing process in a full-thickness skin diabetic wound model. The immunohistochemistry results showed that the GelMA/AA/Cu1.0 hydrogel can promote regular epithelialization and collagen deposition when compared to the TegadermTM Film, GelMA hydrogel, and GelMA/AA/Cu0 hydrogel. The immunofluorescence results confirmed that the GelMA/AA/Cu1.0 hydrogel can reduce the expression of proinflammatory factors and promote angiogenesis. In conclusion, the GelMA/AA/Cu hydrogel is an effective wound dressing to promote the healing process of diabetic skin wounds. Statement of significanceDiabetic wounds exhibit an extremely high risk of bacterial infection and poor angiogenesis in a high-sugar environment, hindering their healing process. Hydrogel wound dressings are a promising wound care material that need to have stable and long-lasting adhesive properties, avoid shedding, provide lasting protection to wounds, antibacterial properties and promote angiogenesis. In this study, a series of self-healing, adhesive, and antibacterial hydrogels based on gelatin methacrylate (GelMA), acrylated adenine (AA), and CuCl2 were designed and synthesized via free radical polymerization, hydrogen bond, and ionic bond to promote diabetic wound healing. Overall, GelMA/AA/Cu hydrogels are promising materials to promote diabetic wound healing.

Emerging roles of the complement system in host-pathogen interactions.

The complement system has historically been entertained as a fluid-phase, hepatically derived system which protects the intravascular space from encapsulated bacteria. However, there has been an increasing appreciation for its role in protection against non-encapsulated pathogens. Specifically, we have an improved understanding of how pathogens are recognized by specific complement proteins, as well as how they trigger and evade them. Additionally, we have an improved understanding of locally derived complement proteins, many of which promote host defense. Moreover, intracellular complement proteins have been identified that facilitate local protection and barrier function despite pathogen invasion. Our review aims to summarize these advances in the field as well as provide an insight into the pathophysiological changes occurring when the system is dysregulated in infection.

Disposable duodenoscopes. Is healthcare system affordability the main hindrance?

The performance of an endoscopic procedure involves introducing an endoscope through the mouth or the anus, which may potentially lead to lethal infection. The risk increases when complex and difficult-to-clean scopes are used, as in the case of duodenoscopes. Side-viewing duodenoscopes are complex in design, with the camera and working channel exit located on one side of the endoscope's distal end, and with an elevator nail also located at this point for catheter redirection. This complex design may facilitate the presence of blind areas not easy to access for cleaning, resulting in suboptimal disinfection of the duodenoscope and therefore a higher risk of bacterial infection. This is of particular importance in particularly vulnerable patients like those who are immunosuppressed (e.g., transplanted patients) or have a malignant disease and are receiving chemotherapy. Moreover, in the era of ¨superbugs¨, like carbapenem-resistant Enterobacteriaceae, infection outbreaks related to endoscopic retrograde cholangiopancreatography (ERCP) have been reported with a significant mortality rate.

Blood transfusion and the risk for infections in kidney transplant patients.

Receipt of a red blood cell transfusion (RBCT) post-kidney transplantation may alter immunity which could predispose to subsequent infection. We carried out a single-center, retrospective cohort study of 1,258 adult kidney transplant recipients from 2002 to 2018 (mean age 52, 64% male). The receipt of RBCT post-transplant (468 participants transfused, total 2,373 RBCT) was analyzed as a time-varying, cumulative exposure. Adjusted cox proportional hazards models were used to calculate hazard ratios (HR) for outcomes of bacterial or viral (BK or CMV) infection. Over a median follow-up of 3.8 years, bacterial infection occurred in 34% of participants at a median of 409 days post-transplant and viral infection occurred in 25% at a median of 154 days post-transplant. Transfusion was associated with a step-wise higher risk of bacterial infection (HR 1.35, 95%CI 0.95-1.91; HR 1.29, 95%CI 0.92-1.82; HR 2.63, 95%CI 1.94-3.56; HR 3.38, 95%CI 2.30-4.95, for 1, 2, 3-5 and >5 RBCT respectively), but not viral infection. These findings were consistent in multiple additional analyses, including accounting for reverse causality. Blood transfusion after kidney transplant is associated with a higher risk for bacterial infection, emphasizing the need to use transfusions judiciously in this population already at risk for infections.